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发表于 2003-5-7 16:32
By Brian Boyle, MD
The clearance of hepatitis B surface antigen (HBsAg) and the appearance of antibody to HBsAg (HBsAb) with normalization of liver function are currently considered evidence of recovery from acute hepatitis B virus (HBV) infection.
Accumulating evidence indicates, however, that this is not the end of the potential consequences of HBV infection and that in some patients HBV DNA sequences persist in the liver for years after patients become HBsAg negative and HBsAb positive. At present, the long-term histologic and virologic impact of an acute, self-limited HBV infection has not been defined.
In a study published in Hepatology, 14 patients were evaluated a median of 4.2 years after their acute, self-limited HBV infection had occurred. All of these patients showed clinical and serologic recovery and were HBsAg negative, with HBsAb present in 12 of the patients.
Of these patients, 9 underwent liver biopsies at a median of 7.2 years following their acute HBV infection. Three of the patients were found to have low levels of circulating HBV DNA up to 8.9 years after their acute infection, and both HBV DNA surface and X regions were found in the liver of all 9 patients examined, including 7 negative for serum HBV DNA.
Liver viral loads assessed by the 2 regions showed a significant correlation and all patients tested positive for covalently closed circular HBV DNA. Finally, liver fibrosis and mild inflammation were present in 8 patients, and the fibrosis stage was found to be related to the peak serum HBV DNA in the acute phase of the HBV infection, but not to liver viral loads in the late convalescent phase.
The authors conclude, “occult HBV infection persists in the liver and is accompanied by abnormal liver histology for a decade after complete clinical recovery from acute self-limited hepatitis B.”
05/02/03
Reference
N Yuki and others. Long-Term Histologic and Virologic Outcomes of Acute
Self-Limited Hepatitis B Hepatology 2003; 37:1172-1179.
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